Infertility affects approximately 15% of couples attempting to conceive, and male factor is known to be either the primary or a contributing factor in at least half of all cases of couple infertility. More than half of male infertility is amenable to microsurgical treatment, but a majority of urology residency programs provide little or no training in male infertility or its microsurgical treatment. Textbooks typically include a chapter or two on surgery of male infertility, but often these chapters only cover basic concepts and simplified overviews and miss the many finer points that are only taught by observing or scrubbing directly in the operating room. Utilizing Dr. Marc Goldstein's extensive surgical experience, this atlas focuses primarily on microsurgical techniques for restoring and preserving male fertility. The chapters discuss surgical anatomy and diagnosis, microsurgery of the vas deferens and epididymis, varicocele and other fertility-related procedures. Topics and techniques include vasectomy, vasovasostomy, vasoepididymostomy, varicocelectomy, hydrocelectomy, and microsurgically assisted inguinal hernia repair. Equipment, instrumentation and training in microsurgery, including animal models, are also discussed. In each chapter, practical tips and tricks are highlighted. Enhanced by plentiful intraoperative photos and original illustrations, Atlas of Male Infertility Microsurgery is an essential resource for male reproductive surgeons, urologists, residents and fellows.
Author(s): Marc Goldstein
Publisher: Springer
Year: 2023
Language: English
Pages: 81
City: Cham
Preface
Acknowledgments
Contents
1: Microsurgical Training
2: Anatomy of the Male Reproductive System
2.1 Introduction
2.2 Landmarks
2.3 Anatomy of the Spermatic Cord
Suggested Reading
3: Microsurgical Subinguinal Varicocelectomy
3.1 Procedure Description
3.2 Partial Occlusion Test
3.3 Completing Vein Ligation
3.4 Vasal Veins
3.5 Delivery of the Testis
3.6 Closure
3.7 Dealing with Complications
3.8 Postoperative Instructions Given to Our Patients
References
4: Microsurgical Hydrocelectomy
4.1 Introduction
4.2 Procedure
4.3 Closure
4.4 Postoperative Instructions
References
5: Microsurgical Spermatocelectomy
5.1 Introduction
5.2 Procedure Description
5.3 Postoperative Instructions
Reference
6: No-Scalpel Vasectomy
6.1 Introduction
6.2 The Vasectomy Consultation
6.3 Procedure Description
6.4 Occlusion Techniques
6.5 Simultaneous Vasectomy and Varicocelectomy
6.6 Post-vasectomy Instructions for Patients
6.7 Vasectomy in Patients with Pre-existing Spermatocele
6.8 Post-vasectomy Pain
References
7: Microsurgical Reconstruction: Decision-Making
7.1 Introduction
7.2 Intraoperative Evaluation of Vasal Fluid
7.3 Vasotomy and Vasogram
7.4 Technique of Vasography and Interpretation of Findings
7.5 Contrast Agents for Vasography
7.6 Complications of Vasography
7.7 Transrectal Vasography and Seminal Vesiculography
References
8: Microsurgical Vasovasostomy
8.1 Microdot Multi-Layer Technique
8.1.1 The Microdot Method Separates the Planning from Suture Placement
8.2 Technique
8.3 Inguinal Obstruction
8.4 Crossed Vasovasostomy
8.5 Transposition of the Testis
8.6 Inguinal Vasovasostomy
8.7 Simultaneous Varicocelectomy and Vasovasostomy: Caveat Emptor
8.8 Simultaneous Sperm Retrieval at the Time of Vasovasostomy or Vasoepididymostomy
8.9 Vasovasostomy or Vasoepididymostomy: Postoperative Care
References
9: Microsurgical Vasoepididymostomy
9.1 Microsurgical End-to-Side Two-Suture Intussusception Vasoepididymostomy
References
10: Microsurgical Epididymal Sperm Aspiration
10.1 Procedure
10.2 Complications
10.3 Conclusion
10.4 Postoperative Instructions
Suggested Reading
11: Microsurgical Testicular Sperm Retrieval
11.1 Procedure
References
12: Transurethral Resection of the Ejaculatory Ducts (TURED)
12.1 Procedure
12.2 Complications
12.3 Conclusion
Suggested Reading
13: Testis-Sparing Excision of Testicular Tumor
13.1 Procedure
13.2 Complications
References
14: Microsurgically Assisted Repair of Inguinal Hernia
14.1 Procedure
14.2 Complications
Reference
15: Final Thoughts
15.1 Thoughts on the Use of Robots in Male Fertility Surgery
15.2 “Goldsteinisms”
15.3 Personalities of Surgeons and Fighter Jocks
15.4 Reflections of a PGY50 Surgeon
References
Suggested Reading
Index
